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TAVI: Asian Perspective

TAVI: Asian Perspective. NUHS National University Health System. Aortic stenosis in Singapore. Tay et al. SMJ 2012 (In press). Tay et al. SMJ 2012 (In press). Mean logistic euroscore: 10.7+/-12.3 Refusal rate for open heart surgery 42.2%. Unique challenges in Asian cohorts.

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TAVI: Asian Perspective

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  1. TAVI: Asian Perspective NUHS National University Health System

  2. Aortic stenosis in Singapore Tay et al. SMJ 2012 (In press)

  3. Tay et al. SMJ 2012 (In press) Mean logistic euroscore: 10.7+/-12.3 Refusal rate for open heart surgery 42.2%

  4. Unique challenges in Asian cohorts Smaller annulus sizes Smaller femoral sizes Smaller LV cavity size More frail?

  5. Aortic root dimensions Tay et al . SMJ 2012 (In press)

  6. Unique challenges in Asian cohorts Smaller femoral sizes Females Males Int J Cardiol 2012 (In press)

  7. Tay & Hon. Asian Cardiovascular and Thoracic Annals 2012 (In press)

  8. Tay & Hon. Asian Cardiovascular and Thoracic Annals 2012 (In press)

  9. Improved functional class Reduction in mean gradient Tay and Hon. Asian Cardiovascular and Thoracic Annals 2012 (In press)

  10. Patient selection Patients are determined to be high risk by two cardiac surgeons Reviewed by TAVI team Decision on TAVI and access

  11. TAVI workup • Traditional • Coronary angiogram and right heart catheterization+/- PCI • Transthoracic and Transesophageal echocardiogram • CT coronary angiogram+aortogram (including ileofemorals) • US carotids, PFT, usual pre-op labs • Determine angles of implant on the on day of procedure

  12. Currently: • Using CT to plan implant angles (if CT available) • Using DynaCT if implant angles not available • Using DynaCT and overlays if aortic aneurysms present

  13. Challenges (1) • With diagnostic CT • Pre-procedural CT with difficult imaging in tachycardic patients/those who are in failure/AF • Renal failure patients an contrast concerns (differences in Asian cohorts)

  14. Challenges (2) • DynaCT • Need for rapid pacing and significant volumes of contrasts • ‘static’ overlays

  15. The ideal situation • Pre-procedure:Minimize pre-procedural scanning/testing eg (1 test provide annulus size, ileofemoral sizes, angle of implant, coronary arteries, calcium volume) • Powerful pre-processing software • Less contrast/less pacing • ‘Dynamic/Live’ overlays • Safe and effective procedural imaging

  16. Clinical National University Heart Centre TAVI program Research Education

  17. Clinical First in Asia series published Maintain the highest quality of care for valvular heart disease patients Standards and outcomes audited according to international TAVI benchmarks

  18. Education Providing training for transcatheter aortic valve implantation in Singapore Providing training to new operators and regional centres in TAVI Incorporating TAVI and hybrid OT technologies in imaging/interventional meetings Fellowship and residency programmes

  19. Research Diagnostic imaging (CT for sizing in access sites Asian patients) Novel biomarker research into aortic stenosis and TAVI Clinical trials and test site for second generation TAVI valves Asian database for valvular heart disease

  20. Thank you

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